The biggest gimmick employed by the bill is that its individual
mandate pushes more than half of the legislation's cost
off-budget, and onto businesses and individuals who will have to
shoulder that burden. A real-world parallel already exists in the
Massachusetts health care plan, where private-sector mandates
account for 60 percent of the cost. In 1994, CBO counted those
mandated private payments in the federal budget, and it helped kill
the Clinton health plan. This time around, Democrats were very
careful to craft their mandates so that they just barely avoided
having the CBO include those payments in the federal budget. But the
CBO's decision does not change the fact that those private-sector
mandates are part of the cost of this bill.
The second-biggest gimmick is assuming that Congress will let the
"Sustainable Growth Rate" cuts in Medicare physician payments to
occur.